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07050255CITY OF CUPERTINO BUILDING DIVISION PERMIT 01A'T�©;� BUI G�D ESS: PERMrr NO. � OAKNOLL CT TBD — TO BE DETERMINED 07050255 : SANITARY NO. CONTROL NO, ARCHITECT/ENGINEER: BUILDING PERMrriNFO BLDG ELECT PLUMB MECH LICENSED CONTRACTOR'S DECLARATION Job Description 1 hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my lkr-= is ADDITION 3 9 4 ' —MA STERBATH EXTENT I ON OF (E ) in full force and effect. , License Gass Lie.. BEDROOM, ADD BATHROOM - # 3 . Date Contractor ARCHITECTS DECLARATION I understand my plans shall be used as public records Licensed Professional OWNER -BUILDER DECLARATION 1 hereby affirm that 1 am exempt from the Contractors License Law for the following reason (Section 7031.5, Business and Professions Code: A❑y city or county which requires a permit to construct altrr, improve, demolish, or repair any structure prior to its issuance, also requires the applicant for such permit to file a signed statement that he is licensed to the of the Conuactors License Law (Chapter 9 Sq. Ft. Floor Area Valuation pursuant provisions 8 4 4 61 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or $ that be is exempt therefrom and the basis for the alleged exemption- Any violation of 3263 9 015 Number Occupancy Type Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars (ssao). :°'�'� ❑ 1, as owner of the property, or my employees with wages as their sole compensation, - Required Inspections will do the work and the structure is not intended oroffered for sale (Sec.7044,Business and Professions Code The Contractor's Licensedoes not Law dnot apply to an owner of - Q p property who builds or improves theacon, and who does such wort himself or through his own employees, provided that such improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner - builder will have the burden of proving that he did not build or Improve for purpose of sale.). ❑ 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec 7044, Business and Professions Code.) Ile Contractors Li- ccnse Law does not apply to an owner of property who builds or improves thereon, and who contracts for such projects with a conractor(s) licensed pursuant to the COmraaors License Law. ❑ 1 am exempt under Sec , B & P C for this reason Owner Dare i C> WORT 'S COMPENSATION DECLARATION i hereby affirm under penalty of perjury one of the following declarations: ❑ 1 have and will maintain a Certificate of Consent to self -Insure for Workers Compen- sadon, as provided for by Section 3700 of the Labor Code, for the performance of the wort for which this permit is issued. ❑ I have and will maintain Workers Compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the wort for which this permit is issued. ' urance surance carrier and Policy number are: My Workers Ins Carrier. Policy No.: CFRTi1ICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE (This section raced not be completed if cite permit Is for one hundred dollars ($100) or less) 1 ttrify OWL in the performance of to the Worker's Compensation provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be dccmed revoked. � CONSTRUCTION LENDING AGENCY I hereby air= that there is a convection Lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.) ' Lender's Name , Lenders Address j 1 certify that I have read this application and state that the above information is ' correct. 1 agree to comply with all city and county ordinances and state laws relating to building construction. and hereby authorise representatives of this city to enter upon the above -mentioned property for inspection purposes. e (We) agree to save, indemnify and keep harmless the City of Cupertino against ( liabilities, judgments, costs and expenses which may in any way accrue against said City _ ' in consequence of the granting of this permit APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON -POINT Issued by: Date R HAZARDOUS MATERIALS DISCLOSURE Will the applicant or future budding occupant store or handle hazardous material as defined by the Cupertino Mumci I Code, Chapter 9.12, and the Health and Safety Code, Swd2! 25532(a)? All roofs shall be inspected prior to any roofing material being installed. ❑ Ycs o If a roof is installed without first obtaining an inspection, I agree to remove Will the applicant or future building occupant use equipment or devices which emit hazardous air comaminams as defined by the Bay Area Air Quality Management all new materials for inspection. District? . ❑ Yes o I have mad the hazardous materials requirements untier Chapter 6.95 of the Cali for- ma Health & Safety Code, Sections 25505, 25533 and 255 34. 1 understand that if the building dos not currently have a ncnanl.that it is my responsibility to notify the occupant of the requirements which